Total Hip Replacement – Precautions


Total Hip Replacement(T.H.R) is a surgical procedure of removing the diseased hip joint and replacing it with an artificial one.

Usually the patients considered for T.H.R are

  1. Young patient
  2. Osteoarthritis of hip joint
  3. Rheumatoid Arthritis
  4. Avascular Necrosis
  5. Septicemia

There is a progressive increase in chronic pain and difficulty in walking, stair climbing and rising froma chair.

Usually there are two types of prosthesis which are commonly used for the surgery: Cemented and Uncemented Prosthesis.

Difference of cemented and uncemented prosthesis:

Cemented prosthesis is usually used in older patients who are less active and have less bone moneral density.

Uncemented Prosthesis is used in younger and more active individuals.

The primary disadvantage of uncemented rposthesis is the extended recovery periof. Because it takes long time for natural bone to grow and attach to prosthesis, hence the person has to limit his activitties for upto 3 months to protect hip.

Your hospital stay my last for a week. If you go home you will need help for several weeks.

The following steps can make your home coming easier:

  • In kitchen as well as other rooms, place items of daily use within reach so you dont have to reach up or bend down.
  • Rearrange furniture you can walk easily with walker or stick.
  • Get a good chair that is firm and higher than average seat.
  • Remove rugs or area rugs that could make you slip.
  • Securely fasten electrical cords around perimeter of the room
  • Install a shower chair grab bar and raised toilet.
  • Use assistive devices such as long handle sponge and grabbing tool or reacher to avoid bending too far.

Once you get home, stay active.The key is not to overdo it while you expect some good and some bad days, you should notice gradual improvement over time.

WEIGHT BEARINGDiscuss with your physical therapist regarding the weight bearing of operated leg as the rehabilitation protocol will be different for cemented and uncemented prosthesis.

STANDING: Move your operated leg first and pushoff the armrest of chair to stand up.

SLEEPING POSITIONS: Sleep on your back with legs slightly apart on your side with abduction pillow.Be sure to use the pillow atleast 6 weeks or untill your doctor tells you to use. Sleeping on stomach is alright.

SITTING: For atleast 3 months donot cross your legs at knees. Make sure the seat height is good so as to avoid bending of hip beyond 90 degreesGet up and move around possibly every 1 hour.

SEX: Some sex positions can be safely resumed 4-6 weeks after surgery. Ask your doctor regarding the same.

CLIMBING: Stair climbing should be limited if possible untill the wound is healed.

Following pattern of stair climbing should be followed.

GOING UP :

  • the unaffected leg should step up first
  • then bring affected leg to same step
  • then bring the cane

GOING DOWN:

  •  put the cane first
  • next bring the affected leg down the step
  • finally step down with unaffected leg.

DRIVING: You can begin driving an automatic car 4 to 8 weeks after consulting your doctor and symptoms after surgery.

SITTING INTO CAR: Be sure the passenger seat is pushed all the back.Recline the seat as far as possible.with the walker in front of you slowly back up the car seat.Swing your legs into the car.Lean back if you need to avoid the hip more than 90 degrees.

GETTING OUT OF THE CAR: Push the seat all the way back.recline the seat and lift your legs out.lean back if you need to.place walker up in front of you and stand up on unaffected leg.

RETURN TO WORK: Depending on the type of activities you eprform it may take as long as 3 months to 6 months to return to work.

OTHER ACTIVITIES: Walk as much as you like once doctor gives you permission, but remember donot substitute walking to exercise.Swimming is recommended once suture are removed and wound is healed.Acceptable activities are dancing, golfing with spike less shoes and cart,bicycling on level road.Avoid activities that involve impact or stress on joints such as tennis, badminton or contact sports like baseball, football,squash, jumping or jogging, Lifting weights is not a problem but carrying heavy and awkward objects that cause to stagger is not advised especially if you must go up and down stairs or slopes.

Do’s and Dont’s

The do’s and dont’s vary depending on orthopaedic surgeons apporach.Your doctor and Physical therapist will provide you with a list of the same to remember with your new hip.The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

 The Dont’s

  • Donot cross legs at knee for atleast 8 weeks
  • donot bring knee up higher han your hip
  • donot lean forward while sitting or as you sit down
  • donot try to pick up something on the floor while ou are sitting
  • donot turn your feet excessively inwards or outwards
  • donot reach down to pull your blanket when lying down
  • donot bend at waist beyond 90 degrees
  • donot use pain as a only guide for what you may or may not do

The Do’s

  • Keep skin dry and clean
  • Notify doctor if wound drains
  • Swelling is normal for first 3-6 months. Elevate leg slightly <30 degrees on pillow and put ice packs for 15-20 min
  • If you get calf pain , chest pain and shortness of breath notify doctor immediately
  • Do exercises prescribed daily.
  • A balanced diet is very important.
  • Maintain an active lifestyle after surgery.

DISCLAIMER: Kindly refer your doctor and Physical therapist for the instructions depending on your surgery procedure.

Physiotherapy to Treat Pelvic Organ Prolapse (Guest Post by DrugWatch.com)


Women diagnosed with Pelvic Organ Prolapse (POP) may feel confused about what the diagnosis means, and what treatments are available. It is important that women become educated on the subject since approximately 50 percent will be diagnosed with it. POP occurs when a weakened pelvic floor allows pelvic organs to fall, or drop, placing pressure on the vagina.

The good news is that many cases of POP, especially cases with very mild to moderate symptoms, can be treated using physiotherapy — physical therapy — rather than surgery. Some surgical procedures, especially those using transvaginal mesh, have been linked to serious and irreversible health complications. Physiotherapy can often reverse the symptoms of POP, allowing women to skip risky surgical treatment altogether.

Can Pelvic Organ Prolapse be Avoided?

One of the most natural ways to avoid POP is to do physiotherapy-based exercises before POP sets in. POP is usually diagnosed in women between the ages of 50 and 79 because menopause is a time when estrogen levels decrease and pelvic tissues become thin and weak.

Pregnancy and childbirth are leading causes of POP. Additional factors include smoking and obesity. Women can be proactive about their pelvic health by leading a healthy lifestyle and doing daily exercises, such as Kegels, to keep pelvic muscles healthy and strong.

Physiotherapy Options for Treating Pelvic Organ Prolapse

Once POP has been diagnosed, there are several safe and effective methods for treating it. Women will want to discuss these options with their doctor before agreeing to surgery.

Pelvic Floor Exercises: Pelvic floor exercises like Kegels, Yoga and Pilates can help to strengthen the pelvic floor and core muscles. This can often reverse mild symptoms and protect organs from prolapsing further.

Pelvic Physiotherapy: There are physical therapists who specialize in pelvic health. A doctor can recommend a pelvic physical therapist who will instruct and guide women through a series of exercises that focus on pelvic muscles to reverse the symptoms of POP. Women with a family history of POP may want to start these exercises when they are young to help prevent POP.

Electrical Stimulation: Doctors can use electrical stimulation to manually strengthen pelvic floor muscles, if Kegel exercises aren’t enough. They also have biofeedback machines that can demonstrate whether a woman is doing pelvic exercises effectively. If the feedback indicates the muscles aren’t being stimulated, a doctor can work to instruct the patient on how to do the exercises more effectively.

Not only is pelvic physiotherapy beneficial for women with POP, it can also help women who experience incontinence. In fact, research demonstrates that women who perform proper Kegel exercises on a daily basis during pregnancy are much less likely to develop incontinence during their third trimester. Continued use of these exercises can prevent incontinence altogether.

Other Non-Invasive Treatments

The American Congress of Obstetricians and Gynecologists has recommended that women with mild to moderate POP opt for more conservative treatments, as opposed to surgical treatments. The organization has also stressed the importance of taking preventative actions against the development of POP.

   Healthy Lifestyle: POP can be prevented. Many of the symptoms of POP are worsened by unhealthy lifestyles, such as smoking and chronic straining, such as with constipation, and obesity. By maintaining a healthy and active lifestyle and weight, the risk of POP can be minimized.

   Vaginal pessary: A pessary is a removable device placed into the vagina, designed to support prolapsed organs. Pessaries hold organs in the correct place before it becomes enlarged and protrudes through the vagina. The pessary is fitted as to not cause discomfort. Symptoms of POP usually improve or go away after pessary use. Risks include wearing of vaginal wall and bleeding; but can be prevented by insuring the device fits correctly.

Working with doctors, and implementing physiotherapy when necessary, can prevent the development of POP and can often reverse existing symptoms of the condition. Transvaginal mesh, a common surgical device used to treat POP, has been determined risky by the Food and Drug Administration.  Thousands of women who are suffering from its use have filed vaginal mesh lawsuits against the manufacturers. Now, it is more important than ever that women do all they can to prevent the need for risky surgical procedures.

For further updates on this condition and its treatments, stay tuned to Fitnesspedia.

Total Hip Replacement


Total Hip replacement is a surgical procedure of removing the diseased the femur head and neck and replacing it with an artificial prosthesis.

Usually the patients considered for the total hip replacements are:

  • Young patient
  • Osteoarthritis of hip joint
  • Rheumatoid arthritis
  • Avascular necrosis
  • Septicemia
There is a progressive increase in chronic pain and difficulty in walking, stair climbing & even rising from a chair.
Difference in Cemented & Uncemented prosthesis:
Cemented prosthesis is usually used in older patients who are less active  and have less bone density.
Whereas uncemented can be used in younger andactive individuals.

The primary disadvantage of uncemented prosthesis is the extended recovery period.
Because it takes a long time for the natural bone to grow and attach to prosthesis, hence the person has to limit his activitites for upto 3 months to protect hip.

Your hospital stay may last for a week, if you go straight home you will need help for several weeks. The following steps can make you homecoming easier:

  1. In kitchen as well as other rooms, place items you use frequently within reach so you dont have to reach up or bend down.
  2. Rearrange furniture so you can walk easuily with walker or stick.
  3. Get a good chair: the one that is firm and higher than average sear
  4. Remove any throw rugs or area rugs that could make u slip.
  5. Securely fasten electrical cords around perimeter of the room.
  6. Install a shower chair, grab bar and raised toilet.
  7. Use assistive devices such as long andle sponge and a grabbing tool or reacher to avoid bending too far.
  8. Wear big pocket shirts or soft shoulder bag for carrying things.

Activities at Home:

  • Keep skin dry and clean,
  • Notify doctor if your wound drains.
  • Swelling is normal for first 3-6 months. elevate leg slightly <30 degrees on pillow and put ice pack for 15 20 min.
  • If u have calf pain, chest pain and shortness of breath notify immediately.

Resuming Activities at Home:
Once you get home, stay active. The KEY is not to overdo it, while you expect some good days and some bad days, you should notice gradual improvement over time.

Weight Bearing
Discuss with you physical therapist regarding the weight bearing of the operated leg as the rehabilitation protocol will be different for cemented and uncemented.

Driving
You can begin driving an automatic car in 4 to 8 weeks after consulting your doctor and your symptoms post surgery.

Sex
Some form of sex positions can be safely resumed 4-6 weeks after surgery. Ask you doctor regarding the same.

Sleeping positions

  • Sleep on you back with legs slightly apart on your side with abduction pillow.
  • Be sure to use pillow atleast 6 weeks ot untill doctor says not to use,Sleeping on stomach is alright,
Sitting
  • For atleast 3 months sit only on chairs that have arms.
  • Do not sit on low chair, reclining chairs.Donot cross your legs at knees.
  • Get up and move around possibly every 1 hour.

Climbing

  • Stair climbing should be limited if possible untill healing is far enough.
  • If you must go up stairs- The unaffected leg should step up first, then bring affected leg up to same step, then bring your cane.
  • To go down- Put cane first, next bring affected leg down to that step, finally step down with unaffected leg

Return to work:
Depending on the type of activiies you perform it may take as long as 3 months or 6 months to return to work.

Other activities:

  • Walk as much as you like once doctor given you go ahead, but remember don’t substitute walking for your prescribed exercise.
  • Swimming is recommended once sutures are removed and wound is healed, apporox 6-8 weeks after surgery,
  • Acceptable activities are dancing, golfing with spikeless shoes and cart , bicycling on level surfaces.
  • Avoid activites that involve impact or stress on joints such as tennis, badminton, contact sports such as baseball, football, squash, jumping or jogging
  • Lifting weight is not problem but carrying heavy awkward object thatr cause you to stagger is not advised esp if you must go up or down stairs or slopes

DOS AND DONTS:
The dos and donts vary depending on orthopaedic surgeon’s approach.
Your doctor and physical therapist will provide you with a list of do’s and dont’s to remember with your new hip.
The precautions will help you to prevent the new joint from dislocation and ensure proper healing.

  • Do not cross your legg at the knees for atleast 8 weeks
  • Do not bring your knee up higher than your hip
  • Do not lean forward while sitting or as you sit down
  • Do not try to pick something onfloor while you are sitting
  • Do not turn your feet excessively inward or outward when you bend down
  • Do not reach down to pull your blankets when lying in bed
  • Do not bend at waist beyond 90 degree
  • Do not stand pigeon toed
  • Do not kneel on knees on un operated leg
  • Do not use pain as a guide for what you may or may not do.
DO cut back on your exercise if your muscle aches but dont stop doing exercise.

Towards a Healthy Menopause…


Menopause marks the opening of the new chapter in women’s life. It is the time when women stops having menstruation.
Menopause can be divided into following phases:
Perimenopause: Its the transition years when the hormonal levels start depleting and women experiences changes at the physical and emotional levels.
Premenopause: These are the years leading up to the last menstrual period.
Post menopause: Its the phase when the women hasn’t experienced the menstrual bleeding minimum 12 months
Women experiences a variety of symptoms as a result of hormonal changes associated with transition through menopause. It occurs in age group of 45-55 years.The hormonal levels decline to a level that menstruation is no longer possible with this shift comes several physical and psychological changes. Its important for women to prepare for these changes by taking good care of their bodies.





SYMPTOMS

  • Hot flushes: It is most common symptom. It is the feeling of warmth that spreads over body, lasting around 30 seconds to few minutes. Flushed(reddened) skin and palpitation and sweating.
  • Urinary incontinence, burning on urination, itching and dryness.
  • Vaginal changes as estrogen affects vaginal lining, experimental women may feel pain during intercourse and may note a change in vaginal discharge.
  • Breast changes: shape changes,signs of atrophy can be seen.
  • Bone loss: The bone loss is rapid in perimenopausal phase.Typically women reaches her peak bone mass by 25-30 years, after that there is decrease in bone mass 0.3% per year.This bone mass is 3% per year in perimenopausal phase which may lead to osteoporosis.Other associated symptoms may be back pain,joint pain.
  • Cholesterol levels: The total cholesterol and LDL (Bad) cholesterol levels increase which leads to increased risk of heart problems.
  • Weight gain
  • Emotional symptoms: Menopause doesn’t always create a series of emotional issues. Some women celebrate the menopause as freedom from birth control concerns or menses.However it is also common to feel unsettled about body changes which seems beyond one’s control.The symptoms include, loss of fertility, aging, loss of sexuality, mood swings, fear of cancer.
But, dear ladies remember; the clouds do eventually lift! meanwhile try alleviating your menopausal symptoms with proper diet and exercise.

EXERCISES TO ALLEVIATE SYMPTOMS OF MENOPAUSE
Even if you’ve never formally exercised, its never too late to start… nor it is too late to reap benefits.The key is to start slowly and do things you enjoy such as:

AEROBIC EXERCISE: Exercises such as walking, cycling, dancing, etc. Aerobics have shown to reduce the stress levels,increase your stamina levels and prevent you from gaining weight.

STRENGTH TRAINING EXERCISES: Low to moderate intensity strengthening exercise helps to build muscle mass which typically is lost due to ageing. Also the bone density increases thus preventing you from getting injuries or osteoporosis. It helps you to increase metabolism and thus preventing from gaining weight.

FLEXIBILITY: It is very important to maintain flexibility of joints and muscles as it prevents from injuries.

Following exercise program can be implemented :
Warm up: active range of motion and mild stretches to major muscle groups
Exercise period: 30-45 min of aerobic exercise
Cool down: slow down the exercise and do stretches.

Make sure all the stretched are held for 15-20 seconds and repeated twice each side.While doing exercise do monitor your heart rate. Perform all exercise atleast 4-5 days a week and alternate 3 days complement aerobic exercise with strengthening of all major, muscles and small muscles group in form of circuit training.

Start aerobic exercises with 50-60% intensity and strengthening can be done by using weights, 40-50% of the weight they can lift maximally for 1 repetition.

STRESS REDUCTION
Aerobics do help to reduce stress.
Tai Chi has also shown positive results for reducing the emotional imbalance caused due to changes in hormones. Meditative exercises and relaxation can done.

Rhythmic Breathing: Rhythmic breathing involves a fixed rhythmic pattern where of inhalation,retention, exhalation,retention is of 2:1:2:1. Don’t hold breathing if you are suffering from blood pressure or any heart disease. 
  • Inhalation 1-2-3-4
  • Pause after inhalation 5-6
  • Exhalation 1-2-3-4
  • Pause after exhalation 5-6
BALANCE EXERCISES
When we reach our 40s,it is not always easy upright. This is because after the age of 25, our balance begins to decrease falls in the later years often result to wrist and hip fractures,which can have devastating effects on lifestyle or even threat to life

Exercise A
Stand directly behind a table or chair and place your feet slightly apart. Lift one leg six inches outside.
Hold the position for 10 seconds.Repeat with the opposite leg.

Exercise B
Stand directly behind a table or chair and place your feet slightly apart. Slowly bend towards your chest lifting your foot six inches off the floor.
Hold the position for 10 seconds and repeat with The opposite leg.

Exercise C
Stand directly behind a table or chair and place your feet slightly apart. Lift one leg back keeping your knee straight.
Hold the position for 10 seconds. Repeat with the opposite leg
The above exercises should be performed 2-3 times a day.

Balance exercise safety guidelines:
Be aware of your posture.Try to maintain your weight over your ankle.
Avoid fast movements including quick turns or changes in position.
Use a chair as a place to not only perform seated exercises but also to hold on to while standing.
always get up slowly when rising from the chair.
Donot close your eyes when exercising or standing from your chair.

T-TAPP exercise
A series of unique movements that are designed to improve spinal alignment, flexibility, strength as well as to build muscle, to improve lymphatic function, raise metabolism and control glucose levels.

YOGA
It helps to maintain flexibility and promote relaxation.



 

                       YOGA POSES
 FOR PERIMENOPAUSAL SYMPTOMS

OTHER MEASURES
  1. Have a regular annual check-up
  2. Breast examination,mammogram
  3. Pap smear
  4. Blood tests
  5. Bone density
  6. Heart risk assessment

Whatever you do,make the commitment now to become more active.Taking control of your health is one way to make menopause a more pleasant experience.

DISCLAIMER :Refer your gynecologist before starting any of the above exercises.